Cervical radiculopathy due to intraforaminal vertebral artery loop – posterior microvascular decompression with graft interposition technique

Background: Vertebral artery (VA) kinking is an uncommon cause of cervical radiculopathy. Here, a 57-year-old patient with unilateral C6 radiculopathy due to an aberrant VA loop documented on both magnetic resonance (MR)/computed tomography angiography (CTA) studies, successfully underwent left-sided C56/C67 foraminotomies resulting in symptom resolution. Case Description: A 57-year-old presented with progressive left C6 and C7 radiculopathy and C6 weakness. Imaging revealed kinking of the VA at the C5–6 level, with the VA arterial loop compressing the left C6 nerve root within the foramen. In addition, degenerative C6–7 foraminal stenosis was noted. Through a C5–6 foraminotomy, meticulous dissection of adhesions between the VA artery and the C6 root was accomplished along with interposition of a Teflon ™ patch. At C6–7, a routine foraminotomy was performed to address C6–7 spondylosis. Postoperatively, the patient experienced complete resolution of his C6 and C7 radiculopathy and C6 motor deficit. Conclusion: Cervical nerve root compression may rarely be attributed to abnormal foraminal VA loops. Obtaining the appropriate preoperative MR imaging/CTA is critical to diagnose VA compromise, and plan for unilateral foraminal decompressions.